Immunosuppressant Therapy Adherence Scale Research Articles

Mindfulness-based cognitive therapy for adherence of immunosuppressive treatment in liver transplant recipients: A randomized controlled trial

ObjectiveThe aim of this study was to analyze the effects of mindfulness-based cognitive therapy on the adherence of liver transplant recipients to immunosuppressive therapy with a randomized controlled design. MethodThis randomized controlled trial was performed with 120 liver transplant recipients hospitalized at the liver transplant department of a research and practice hospital (n = 120). While we administered no intervention to the patients in the control group (n = 60), we provided Mindfulness-Based Cognitive Therapy to those in the experimental group (n = 60). We used the Mindful Attention Awareness Scale and the Immunosuppressant Therapy Adherence Scale to collect data. We utilized descriptive statistics, paired-samples t-tests, independent-samples t-tests, one-way analysis of variance, and chi-squared tests to analyze the data. ResultsAfter the intervention, the immunosuppressive therapy adherence levels of the experimental group increased significantly (p < 0.01). On the other hand, the control group had significantly higher adherence to immunosuppressive therapy and significantly higher levels of mindfulness in the pretest phase than it did in the posttest phase (p < 0.01). ConclusionsComplete adherence to immunosuppressive therapy is imperative for the prevention of graft rejection in liver transplant recipients. In our study, the experimental group equipped with enhanced mindfulness had higher adherence to immunosuppressive therapy. Therefore, the use of Mindfulness-Based Cognitive Therapy in the promotion of adherence to immunosuppressive therapy is recommended.

The analysis of the adherence of liver transplant recipients to immunosuppressant treatment, their self-control, and self-management in the post-transplantation period

In our study, it was aimed to investigate the adherence of liver transplant recipients to immunosuppressant therapy, their self-control, and their self-management in the post-transplantation period. The sample of this descriptive and cross-sectional study was composed of liver transplant recipients. The personal information form, Immunosuppressant Therapy Adherence Scale, and the Liver Self-Control and Self-Management Scale were used to collect data, and descriptive statistical methods, independent samples t-test and one-way analysis of variance analysis was used to analyze the collected data. In light of the data collected in this study, it was identified that, of all recipients, 73.6% were 45–64 years old, 72.5% were male, 25.2% were workers, and 44.6% had equivalent income and expenses. It was observed that the recipients did not fully adhere to the immunosuppressant therapy regimen, and their self-control and self-management levels were below the medium level. The social support system of liver transplant recipients is very important. Recipients with a good social support system can receive caregiver support from their relatives, thereby supporting their self-control and self-management. Both liver transplant patients and the people providing care to them should be simultaneously provided with training programs and given information, and both groups should be supported in treatment and care processes.

Assessment of the Effectiveness of Patient Education and Interviews in Improving Medication Adherence of Renal Transplant Recipients.

Background Non-compliance with immunosuppressive drugs has been reported as the most significant cause of graft loss.Since non-compliance with immunosuppressive drugs is preventable, certain approaches based on the risk factors and causes of non-compliance can help eliminate this problem. Aims The purpose of this study is to assess the effectiveness of patient education and interviews in improving medication adherence of renal-transplant recipients. Materials and methods This study was designed as a randomized controlled trial. Using the G*Power program, the sample size was calculated as 60 subjects, with 30 in both the intervention groupand control group.Data collection tools included a patient information form,a pretest-posttest, a drug monitoring form for kidney transplant patients,the Immunosuppressive Therapy Adherence Scale, measurement of tacrolimus blood levels,and a training booklet. Results The mean knowledge score in the intervention group was 12.17±3.39 at baseline, and it increased to 20.73±1.57 after the intervention. The mean scores on the Immunosuppressant Therapy Adherence Scale were 11.67±0.55 and 10.70±0.99 in the intervention group and control group, respectively. There was a statistically significant difference between the pre-test and post-test means on the Immunosuppressant Therapy Adherence Scale in the intervention group. The mean Immunosuppressant Therapy Adherence Scalescore was higher in the intervention group. In the measurement of tacrolimus blood levels, medication adherence was found the be higher in the intervention group. The difference between the groups was statistically significant. There was a positive correlation between the tacrolimus blood levels and the Immunosuppressant Therapy Adherence Scalescores in both groups. Conclusions To conclude, our results have demonstrated that patient education and interviews improve immunosuppressant medication adherence in renal transplant recipients. Using direct or indirect methodsproved similar outcomes, suggesting that both evaluation methods are safe.

The analysis of immunosuppressant therapy adherence, depression, anxiety, and stress in kidney transplant recipients in the post-transplantation period

AimOur study aimed to analyze the immunosuppressant therapy adherence, anxiety, stress, and depression in kidney transplant recipients in the post-transplantation period. MethodThis study was conducted as descriptive and cross-sectional research with the participation of 260 recipients who underwent kidney transplantation and were already discharged from the hospital (n = 260). In the data collection process, we used the Personal Information Form, the Immunosuppressant Therapy Adherence Scale (ITAS), and the Depression Anxiety Stress Scale (DASS)-21. The One-Way Analysis of Variance (ANOVA), Chi-Squared test, post hoc and Pearson Correlation analysis methods were used in data analysis. FindingsIn our study all participant kidney transplant recipients, 45.4% were age 46–64 years and 81.5% were men. As the recipients' age levels increased, their immunosuppressant therapy adherence levels decreased (p < 0.05). Similarly, kidney recipients with at least 3 adverse events (infection, gastrointestinal problems, edema, blood disorders etc.) had a higher DASS-21 score and a lower ITAS score than those with low side effects. ITAS had a strong negative relationship with DASS-21 (p < 0.05). Recipients' depression, stress, and anxiety scores were, in general, above the medium level. ConclusionAdherence to the immunosuppressive drug regimen after kidney transplantation and depression, anxiety and stress are in a bidirectional relationship. At the same time, the side effects of immunosuppressive drugs can trigger the development of depression, anxiety and stress. After kidney transplant, recipients are at risk for the development of depression, anxiety, and stress. We recommend early detection of this condition and taking preventive and symptom-reducing interventions.

Investigation of adherence to immunosuppressive therapy and spiritual well-being in liver recipients

ObjectiveIn our study, we investigated the relationship between spiritual well-being and adherence to immunosuppressive therapy after liver transplantation. MethodWe conducted this descriptive and cross-sectional study with the participation of 131 liver transplant recipients after they had received their transplants. Data collection was carried out using a Personal Information Form, the Spiritual Well-Being Scale and the Immunosuppressant Therapy Adherence Scale. The IBM Statistical Package for the Social Sciences 25.0 was used for the statistical analyses. ResultsWhile 73.3% of the patients were at the ages of 45–64, 72.5% were male, and 39.7% had been using immunosuppressive medication for a period between 6 months and 1 year. The rate of corticosteroid use among the patients was 30.5%, and the rate of antimetabolite use was 21.4%. A positive and significant relationship was found between adherence to immunosuppressive treatment and spiritual well-being (B = 0.425, p = 0.017). ConclusionSpiritual well-being is an inexpensive, effective and easy strategy to increase adherence to immunosuppressive treatment. Awareness should be raised in physicians and nurses about the importance of spiritual well-being, and they should be encouraged to support spiritual well-being.

The effect of adherence to immunosuppressant therapy on gastrointestinal complications after liver transplantation

AimIn our study, we examined the relationship between gastrointestinal system problems and adherence to immunosuppressant therapy after liver transplantation. MethodWe performed this study as descriptive and cross-sectional research with the participation of liver transplant recipients. In the data collection, we used the Personal Information Form, the Gastrointestinal Symptom Rating Scale, and the Immunosuppressant Therapy Adherence Scale. In the data analysis, we utilized the IBM Statistical Package for Social Science 25.0. FindingsIn our study, it was discerned that, of all liver transplant recipients (n = 331), 45.9% were aged 45–64 years, 77.3% were male, and 93.4% were married. Besides, 36.9% of liver transplant recipients were utilizing immunosuppressive agents for 1 month – 89 days. Next, it was identified that liver transplant recipients mostly used tacrolimus (67.4%), mycophenolate mofetil (65.6%), and prednisolone (76.7%). It was found that tacrolimus, mycophenolate mofetil, biological agents, and other immunosuppressants were associated with the development of gastrointestinal system problems. ConclusionThe management of gastrointestinal system disorders is extremely importance to ensure that liver transplant recipients can adhere to immunosuppressant therapy. The awareness of liver transplant recipients about gastrointestinal system disorders and complications should be increased and their management should be assisted.

A Prospective Survey of Outpatient Medication Adherence in Adult Allogeneic Hematopoietic Stem Cell Transplantation Patients.

Limited data exist regarding the prevalence and outcome of medication nonadherence in the adult allogeneic hematopoietic stem cell transplantation (allo-HSCT) population. The objective of this cross-sectional survey study is to determine the prevalence of medication nonadherence to immunosuppressant and nonimmunosuppressant medications in adult recipients of allo-HSCT. An electronic survey using previously validated medication adherence scales was distributed between December 2014 and April 2015 to 200 adult patients with at least 3 months of follow-up after allo-HSCT. Immunosuppressant serum drug levels and prescription refill records were retrospectively collected to assess correlation with survey responses. In the entire cohort, 51% of subjects (n=102) reported nonadherence to nonimmunosuppressant medications (95% confidence interval [CI], 44.07% to 57.93%) on the Morisky Medication Adherence Scale. Of the 153 patients taking oral immunosuppressant medications at the time of the survey, 58 (37.9%) reported nonadherence to immunosuppressant therapy (95% CI, 30.22% to 45.6%), as measured by the Immunosuppressant Therapy Adherence Scale. Younger age and distress were associated with medication nonadherence. Nonadherence to immunosuppressant therapy was associated with mild chronic graft-vs-host disease (cGVHD), and a similar trend was observed for moderate cGVHD. Medication nonadherence was found to be highly prevalent for both immunosuppressant and nonimmunosuppressant medications in adult allo-HSCT recipient, and further study to identify interventions to improve adherence in these patients is warranted.

The Portuguese Version of the Immunosuppressant Therapy Adherence Scale (ITAS) among Liver Transplant Recipient Patients: Translation and Psychometric Properties

Introduction and aim. Transplant recipients are chronically ill patients who rely on medical treatment throughout life to achieve positive results. Despite that, medication nonadherence after liver transplantation is extremely common. The self-report, one of several methods for measuring adherence, is easy to apply and low cost. Thus, this study aims to translate and validate the Immunosuppressant Therapy Adherence Instrument (ITAS) in Brazilian Portuguese for liver transplant recipients.Material and methods. A total of 139 liver transplant recipients were selected from a general hospital, who were assessed by using the Portuguese version of ITAS. The scale was translated based on the model proposed by Wild, et al. and its psychometric properties were assessed.Results. The average Cronbach’s a coefficient was 0.830. ITAS and Basel Assessment of Adherence with Immunosuppressive Medications Scale (BAASIS) presented significant correlation, with a Spearman’s p coefficient = 0.300 (S = 309,580; p < 0.001). The area under the receiver operating characteristics (ROC) curve was 0.638 (95% CI: 0.557 – 0.715). Factor analysis results indicated that the carelessness factor model was the optimal model, and the factor “feeling worse” was the lowest.Conclusion. The Portuguese version of ITAS has adequate psychometric properties to measure adherence to immunosuppressant therapy.

Organ Nakli Alıcıları İçin İmmunosupresif Tedaviye Uyum Ölçeği: Türkçe Geçerlik ve Güvenilirlik Çalışması

Organ Nakli Alıcıları İçin İmmunosupresif Tedaviye Uyum Ölçeği: Türkçe Geçerlik ve Güvenilirlik Çalışması

Immunosuppressive Medication Adherence, Therapeutic Adherence, School Performance, Symptom Experience, and Depression Levels in Patients Having Undergone a Liver Transplant During Childhood.

This study sought to investigate immunosuppressive medication adherence, therapeutic adherence, school performance, symptom experiences, and depression levels of patients having undergone liver transplant during childhood. We performed a retrospective, cross-sectional, case-controlled study to compare the depression levels of subjects with those of their healthy peers. Data were collected between June 23, 2014, and July 10, 2014, from 0- to 18-year-old patients having undergone a liver transplant between 1996 and 2014 (n = 27; the participant's mean age, 17.59 y [SD = 4.29, min-max = 8-28 y]). The mean score for the immunosuppressant therapy adherence was 11.18. To collect the data, the Demographic and Clinical Characteristics Form, Immunosuppressant Therapy Adherence Scale, Therapeutic Regimen Adherence Assessment Questionnaire, School Performance Assessment Questionnaire, Modified Transplant Symptom Occurrence and Symptom Distress Scale-58, and Beck Depression Inventory were used. To analyze the data, descriptive statistics (frequencies, mean, and standard deviation), Mann-Whitney U test, and ridit scoring were used. While the rate of adherence with clinical appointments was 55.5%, it was 33.3% with the diet (prescribed regimen) and 44.4% with exercise. While 33.3% of the participants repeated a grade or were held back, 44.4% of them missed more than 20 school days. Of the symptoms, the recipients mostly experienced anxiety, restlessness, nervousness, fatigue, and difficulty in concentrating. The patients' mean depression score was 7.77 when they were compared to their healthy peers, the difference was not statistically significant (P > .05). In our study, the recipients' adherence with immunosuppressive therapy and clinical appointment was high. This study will provide data for the literature about pediatric liver transplant recipients' adherence with diet and exercise, and physiological and psychological symptoms such as fatigue and anxiety.

Relationship between immunosuppressive medications adherence and quality of life and some patient factors in renal transplant patients in Iran.

Background & Aim:About organ transplant, immunosuppressive medications adherence is a critical issue, because non-adherence to these medications causes rejection, reduces quality of life and increases treatment cost and mortality rate. Among these, the quality of life is deemed very important to evaluate treatment result and also it can be useful for discovering non adherence. The aim this study was to assess the relationship between medication adherence and quality of life and some patient factors in renal transplant patients.Methods:The study was a descriptive-correlational design and was done on renal transplant patients over 18 who had undergone surgery for over 3 months, and were inclined to participate. Sample size was 230 people and sampling was convenience. Quality of life questionnaire in renal transplant patients and Immunosuppressant Therapy Adherence Scale were filled by patients and the data was analyzed by SPSS15 software.Results:It showed that the mean score of quality of life in renal transplant patients was 21.65±4.03 and 57.8% of them did not adhere to immunosuppressive medications. Results of correlation between scores of immunosuppressive medication adherence and Quality of life showed that there were significant correlation in 3 dimensions of 4: health performance (p≤0.0001 & rETA=0.23), social-economic (p=0.001 & rETA=0.15), psychological-spiritual (p=0.011 & rETA=0.15), also logistic test showed significant relationship between immunosuppressive medication adherence and number of transplantation (β=1.04, p= 0.048).Conclusion:According to the results, health care providers i.e. nurses must note to medication adherence as a health enhancement factor while treating and educating to these patients.

A longitudinal assessment of adherence with immunosuppressive therapy following kidney transplantation from the Mycophenolic Acid Observational REnal Transplant (MORE) study.

Nonadherence with immunosuppressive therapy after renal transplantation is a major clinical concern, but longitudinal data are sparse. Adherence data were recorded during the Mycophenolic Acid Observational REnal Transplant (MORE) study to help inform compliance management decisions. Prospective data were analyzed from the four-year, observational MORE study of de novo adult renal transplant recipients receiving mycophenolic acid (MPA) as enteric-coated mycophenolate sodium (EC-MPS) or mycophenolate mofetil (MMF) at 40 US sites under routine management. Adherence was assessed using the Immunosuppressant Therapy Adherence Scale (ITAS): total score 0-12 (12, adherence; <12, nonadherence). A logistic regression model was used to identify factors associated with nonadherence. In total, 808/946 recipients (85.4%) provided ≥1 ITAS score. Nonadherence was reported by 24.8%, 31.5%, 33.0%, 39.8%, 35.4% and 26.4% at months 3, 6, 12, 24, 36 and 48, respectively. Mean ITAS score was higher with EC-MPS vs. MMF at months 24 (11.3[1.0] vs. 10.9[1.4], p=0.001) and 36 (11.4[1.0] vs. 11.1[11.3], p=0.024). The odds ratio for nonadherence was 1.60 (95% CI 1.17, 2.19; p=0.003) for African Americans vs. non-African Americans. The rate of biopsy-proven acute rejection was 12.7% (51/401) in nonadherent recipients vs. 11.3% (46/406) in adherent recipients (p=0.59); graft loss was 4.7% (19/402) vs. 3.0% (12/406) (p=0.20); death was 1.5% (6/402) vs. 4.7% (19/406) (p=0.013). Adherence to the immunosuppressive regimen decreases over time, highlighting the need to monitor and encourage adherence even in long-term maintenance kidney transplant patients. Other than African American race, demographic factors may be of limited value in predicting nonadherence.

Awareness of Memory Impairment Increases the Adherence to Immunosuppressants in Kidney Transplant Recipients

ObjectivesNonadherence to immunosuppressive drugs is a concern among kidney transplantation recipients (KTRs). The adverse effects of immunosuppressive drugs can trigger nonadherence and lead to a great impact on the allograft survival. The aim of this prospective controlled study is to determine the major adverse effects of immunosuppressive drugs and their correlation with the nonadherence in kidney transplantation recipients. MethodsAll data were collected from medical and pharmacy records. We use modified Immunosuppressant Therapy Adherence Scale combined with Modified Transplant Symptom Occurrence and Symptom Distress scale to explore the relationship between symptom experience related to side effects of immunosuppressants and adherence. The risk of nonadherence was estimated by stepwise logistic regression while controlling for age, gender, education, and immunosuppressive medications. Multivariable analysis was performed using a single random effect of P < .2. ResultsIn total, 412 KTRs completed the structured self-report instrument. The weekly pill counts were 84.2 ± 39.8. Overall, 21.4% of patients were nonadherent to immunosuppressive drugs. The most common adverse effects of immunosuppressive drugs were memory impairment (28.4%), insomnia (26.0%), gastrointestinal discomfort (21.4%), easy fatigue (22.1%), hand tremor (23.8%), and vision variation (29.1%). Multivariate analysis revealed that the adherence increased in patients with awareness of memory impairment (odds ratio 2.320, 95% confidence interval: 1.259–4.274, P = .007). There was no significant difference in the incidence of acute rejection, gender, age, and education between adherent and nonadherent patients. ConclusionIn summary, these results indicate a significant prevalence of nonadherence to immunosuppressive drugs in kidney transplantation recipients. Awareness of memory impairment significantly affected adherence to immunosuppressive drugs.

Rurality and other factors associated with adherence to immunosuppressant medications in community-dwelling solid-organ transplant recipients

BackgroundData on immunosuppressant adherence of community-dwelling adult solid-organ transplant recipients (SOTRs) from rural populations in the United States are limited. Therefore, understanding the association of rurality and other factors of immunosuppressant adherence will help providers design and deliver patient-centered adherence enhancing interventions. ObjectivesThe objective was to examine factors associated with a previously validated 4-item Immunosuppressant Therapy Adherence Scale (ITAS) score in community-dwelling adult SOTRs who received a transplant from an academic center in the Midwestern United States. MethodsFor this observational study, cross-sectional survey data (patient demographic, medical condition, immunosuppressant therapy, and self-reported ITAS) received from adult SOTRs aged 19 years or older with other data from an academic transplant center’s database were merged. Using multivariate logistic regression, significant SOTR characteristics associated with being adherent (ITAS score=12) versus nonadherent (ITAS score <12) were examined. ResultsThe survey response rate was 30% (n=556/1827). Those SOTRs responding (n=556) had a kidney (48%), liver (47%), or other (4.5%) transplant. They were more likely to be 50- to 64-year olds (52%), men (55%), white (90%), metroresident (59%), with an annual income less than $55,000. The SOTRs were living with a transplant for 6.3 years (median), reported excellent-to-good health status (77%), and received different immunosuppressant regimens. More than half of the SOTRs (58%) were adherent. In multivariate analyses, compared with patients aged 65 years or older, younger patients, nonmetro rural- versus metroresident, and those having more (≥6) versus less (<6) comorbidities were significantly less likely to report adherence. SOTRs receiving tacrolimus-based combination immunosuppressant versus tacrolimus alone were more likely to report adherence. ConclusionsWhen designing and delivering patient care-centered interventions including those that use technology to increase immunosuppressant adherence, providers need to consider rural residence besides other well-established patient factors (younger age, immunosuppressant drug, and comorbidities) of nonadherence.

Social support and immunosuppressant therapy adherence among adult renal transplant recipients

The purpose of the study was to assess the relationship between social support and immunosuppressant therapy adherence among adult renal transplant recipients. A cross-sectional, survey design was employed. Mailed questionnaires were used to collect data from 81 recipients, and included the Immunosuppressant Therapy Adherence Scale (ITAS and Modified Social Support Survey (MSSS-5). The correlation between ITAS and MSSS-5 summary scores was assessed using the correlation coefficient (r). Analyses of the following relationships were conducted using correlation coefficients: (i) ITAS summary score and individual items of the MSSS-5; and (ii) MSSS-5 summary score and individual items of the ITAS. A hierarchical regression was conducted. The response rate was 74%. The relationship between social support and adherence was significant (r = 0.214, p < 0.05). Two MSSS-5 items (affectionate support and instrumental support pertaining to household functions) were related to ITAS summary score (p < 0.05), and one ITAS item (forgetfulness) was related to the MSSS-5 summary score (p < 0.05). The regression model (all MSSS-5 items) accounted for 24% of the variation in ITAS summary scores. The findings suggest that strategies utilizing social support to address forgetfulness as well as strategies to improve affectionate support and instrumental support related to daily household functions may be useful adherence intervention tools.

Psychometric re‐evaluation of the immunosuppressant therapy adherence scale among solid‐organ transplant recipients

The objective of this study was to conduct a psychometric re-evaluation of the immunosuppressant therapy adherence scale (ITAS), a self-report measure of immunosuppressant therapy (IST) adherence targeted to solid-organ transplant recipients. Mailed questionnaires were used to collect data from 141 transplant recipients. A factor analysis of the ITAS was conducted. Validity was examined via Pearson's product-moment correlations (r) to theoretically tied measures of social support and resilience. Cronbach's and split-half alpha coefficients determined internal consistency. The response rate was 72.3%. The aggregate mean on ITAS' summed scores was 11.0 (standard deviation = 1.7). The single IST adherence factor had an eigenvalue of 2.92 and accounted for 73% of the scale items' variance. Component loadings for ITAS items were high (> or = 0.80). Zero-order correlations among scale items were moderately strong (> or = 0.57) and significant (P < 0.01). ITAS summed scores were significantly associated with measures of social support and resilience (r > or = 0.20, P < 0.05). Cronbach's alpha was 0.87. The Guttman split-half coefficient was 0.90. This re-evaluation provides needed confirmation that the ITAS is a valid and reliable measure of IST adherence. The ITAS may be useful as an IST adherence measure in the outpatient transplant clinic setting as it is easy to administer, brief and less expensive than many other adherence measures.

Patient factors associated with adherence to immunosuppressant therapy in renal transplant recipients

Factors associated with adherence to immunosuppressant therapy (IST) in renal transplant recipients were studied. The Immunosuppressant Therapy Adherence Scale (ITAS) was completed by adult renal transplant recipients in Georgia. Those completing the ITAS were classified as adherent to IST if their ITAS score were 12 and nonadherent if their score was less than 12. The relationship between the dichotomized ITAS scores and patient variables that are readily available to clinicians, such as sex, age, kidney donor type, income, marital status, race or ethnicity, and time since transplantation, was assessed. The relationship of ITAS scores to patients' clinical and pharmacy data (e.g., graft rejection, serum IST concentrations, serum creatinine [SCr] concentrations, and pharmacy refill-based adherence rates) was also assessed. One hundred thirty-seven patients completed the ITAS. Eighty-nine patients (65%) were adherent to IST, and the remaining 48 (35%) were nonadherent. Patient sex was unrelated to adherence. Compared with nonadherent patients, adherent patients tended to be younger, to take cyclosporine, to have lower incomes, to have received their transplant more recently, to have targeted immunosuppressant concentrations, to have greater refill-based adherence rates, and to be less likely to exhibit an increase in SCr concentration (p < 0.05). There was no significant difference in the number of rejections between adherent and nonadherent patients. Patient age, income, time since transplantation, and the immunosuppressant agent prescribed were associated with IST adherence.

Development and validation of the immunosuppressant therapy adherence instrument (ITAS)

A five-item scale was developed that asked respondents to indicate how often they were non-adherent to immunosuppressant therapy (IST) given a particular circumstance. Two hundred and twenty-two recipients completed the instrument. Validity of the scale was assessed by correlating composite item scores with refill record adherence rates (RRARs), serum immunosuppressant (IS) concentrations, graft rejection, and increased serum creatinine (SCr) levels. One scale item was deleted due to lack of response variability. Cronbach's alpha coefficient for the four-item scale was 0.81, demonstrating that the scale has acceptable reliability. All items loaded on a single principal component, suggesting that the scale measures a single adherence construct, which accounted for 64% of the scale items’ variance. The four-item scale, adherence measured by IS RRARs, and “target” IS serum concentrations had positive correlations ( p < 0.01). Item scores were shown to be negatively related to rejection occurrence and increased SCr ( p < 0.05). The immunosuppressant therapy adherence scale is the first published, valid and reliable instrument that measures recipients IST adherence.